scholarly journals Common Bile Duct Exploration in an Elderly Asian Population

2015 ◽  
Vol 100 (2) ◽  
pp. 261-267 ◽  
Author(s):  
Vishal G. Shelat ◽  
Vincent J. M. Chia ◽  
JeeKeem Low
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Elderly Patients ◽  
Laparoscopic Approach ◽  
Asian Population ◽  
Laparoscopic Group ◽  
The Elderly ◽  
Common Bile Duct Exploration ◽  
Group A ◽  
Group B

Common bile duct exploration (CBDE) is an accepted treatment for choledocholithiasis. This procedure is not well studied in the elderly population. Here we evaluate the results of CBDE in elderly patients (>70 years) and compare the open (group A) with the laparoscopic group (group B). A retrospective review was performed of elderly patients with proven common bile duct (CBD) stones who underwent CBDE from January 2005 to December 2009. There were 55 patients in group A and 33 patients in group B. Mean age was 77.6 years (70–91 years). Both groups had similar demographics, liver function tests, and stone size—12 mm (range, 5–28 mm). Patients who had empyema (n = 9), acute cholecystitis (n = 15), and those who had had emergency surgery (n = 28) were more likely to be in group A (P < 0.05). The mean length of stay for group A was 11.7 ± 7.3 days; for group B, 5.2 ± 6.3 days; the complication rate was higher in group A (group A, 38.2%; group B, 8.5%; P = 0.072). The overall complication and mortality rate was 29.5% and 3.4%, respectively. CBDE can be performed safely in the elderly with accepted morbidity and mortality. The laparoscopic approach is feasible and safe in elective setting even in the elderly.

scholarly journals Adding ursodeoxycholic acid to the endoscopic treatment and common bile duct stenting for large and multiple biliary stones: Will it improve the outcomes?

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ahmad Hormati ◽  
Mohammad Reza Ghadir ◽  
Seyed Saeed Sarkeshikian ◽  
Faezeh Alemi ◽  
Majid Moghaddam ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Ursodeoxycholic Acid ◽  
The Elderly ◽  
Success Rates ◽  
Biliary Stones ◽  
Cbd Stones ◽  
Group A ◽  
Bile Duct Stenting ◽  
Group B

Abstract Background The role of common bile duct (CBD) stenting in the establishment of bile stream in the elderly patients and the ones who are not good candidates for surgery due to not responding to treatments was well documented in previous studies. The current study aimed at investigating the effect of adding Ursodeoxycholic acid (UDCA) to CBD stenting alone in order to reduce the size of large and multiple CBD stones. Methods Clinical outcomes including success rates in CBD stones clearance, incidence of pancreatitis, perforation, bleeding, as well as, decrease in size of stones and liver enzymes after a two-month period were assessed in the UDCA + CBD stenting group. Results A total of 64 patients referring to Shahid Beheshti Hospital in Qom, Iran with multiple or large CBD stones (above three or larger than 15 mm) received standard endoscopic therapies and UDCA + CBD stenting (group B) and controls only received standard endoscopic therapies with only CBD stenting (group A). The mean reduction in the size of stones in group B was significantly higher than that of group A (3.22 ± 1.31 vs 4.09 ± 1.87 mm) (p = 0.034). There was no difference in the incidence rate of complications including pancreatitis, cholangitis, bleeding, and perforation between the two groups (P > 0.05). Conclusion Adding UDCA to CBD stenting, due to decrease in the stone size and subsequently facilitation of the stones outlet, can be considered as the first-line treatment for patients with large and multiple CBD stones. Also, in the cases with large or multi stones may be effective in reducing size and subsequently stone retrieval. Trial registry The study protocol was approved by the Ethics Committee of Qom University of Medical Sciences (ethical code: IR.MUQ.REC.1397.075); the study was also registered in the Iranian Registry of Clinical Trials (No. IRCT20161205031252N8). This study adheres to CONSORT guidelines.

Primary Closure Versus T-Tube Drainage Following Laparoscopic Common Bile Duct Exploration in Patients With Previous Biliary Surgery

2020 ◽  
pp. 000313482094739
Author(s):  
Wan Zhen ◽  
Wang Xu-Zhen ◽  
Fu Nan-Tao ◽  
Li Yong ◽  
Xiao Wei-Dong ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Primary Closure ◽  
Common Bile Duct Exploration ◽  
Biliary Surgery ◽  
Tube Drainage ◽  
T Tube ◽  
Significant Difference ◽  
Group A ◽  
Group B

Laparoscopic common bile duct exploration (LCBDE) has been recently introduced for management of CBD stone in patients with previous biliary surgery history. The aim of this study was to evaluate the safety and effectiveness of primary closure in patients with previous biliary surgery history compared to T-tube drainage. Eighty patients with previous biliary surgery history including laparoscopic cholecystectomy, open cholecystectomy, or open common bile duct exploration were enrolled in the retrospective study. The patients were divided into 2 groups according to the methods of choledochotomy closure. Group A: patients with primary closure after LCBDE (n = 51); group B: patients with T-tube drainage after LCBDE (n = 29). Group A exhibited a shorter postoperative hospital stay and lower hospitalization expenses compared to group B. There was no significant difference in conversion rate to open surgery, operating time, intraoperative blood loss, bile leakage rate, overall complication rate, and stone recurrence rate between the 2 groups. Biliary stricture was not observed in the 2 groups during the follow-up period. Primary closure following LCBDE is safe and effective for the management of CBD stones in patients with previous biliary surgery history.

Laparoscopic Common Bile Duct Exploration with Primary Closure for Management of Choledocholithiasis: A Retrospective Analysis and Comparison with Conventional T-tube Drainage

2014 ◽  
Vol 80 (2) ◽  
pp. 178-181 ◽  
Author(s):  
Hong-Wei Zhang ◽  
Ya-Jin Chen ◽  
Chang-Hao Wu ◽  
Wen-Da Li
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Stay ◽  
Primary Closure ◽  
Bile Leakage ◽  
Common Bile Duct Exploration ◽  
Tube Drainage ◽  
T Tube ◽  
Group A ◽  
Group B

Laparoscopic common bile duct exploration (LCBDE) had become one of the main options for management of choledocholithiasis. This retrospective comparative study aimed to evaluate on the feasibility and advantages of primary closure versus conventional T-tube drainage of the common bile duct (CBD) after laparoscopic choledochotomy. In this retrospective analysis, 100 patients (47 men and 53 women) with choledocholithiasis who underwent primary closure of the CBD (without T-tube drainage) after LCBDE (Group A) were compared with 92 patients who underwent LCBDE with T-tube drainage (Group B). Both groups were evaluated with regard to biliary complications, hospital stay, and recurrence of stones. The mean operation time was 104.12 minutes for Group A and 108.92 minutes for Group B ( P = 0.069). The hospital stay was significantly shorter in Group A than that in Group B (6.95 days and 12.05 days, respectively; P < 0.001). In Group A, bile leakage occurred in two patients on postoperative Day 2 and Day 3, respectively. In Group B, bile leakage noted in one patient after removal of the T-tube on Day 14 after operation ( P = 1.000). With a median follow-up time of 40 months for both groups, stone recurrence was noted in two patients in Group A and three patients in Group B ( P = 0.672). Primary closure of the CBD is safe and feasible in selected patients after laparoscopic choledochotomy. It results in shorter duration of hospital stay without the need for carrying/care of a T-tube in the postoperative period and similar stone recurrence as that of the conventional method.

Laparoscopic Common Bile Duct Exploration Is a Safe and Effective Strategy for Elderly Patients

2018 ◽  
Vol 25 (5) ◽  
pp. 465-469 ◽  
Author(s):  
Wen-song Liu ◽  
Yong Jiang ◽  
Dong Zhang ◽  
Long-Qing Shi ◽  
Dong-Lin Sun
Keyword(s):  
Bile Duct ◽  
Postoperative Complications ◽  
Common Bile Duct ◽  
Elderly Patients ◽  
Chronic Diseases ◽  
Heart Diseases ◽  
The Elderly ◽  
Common Bile Duct Exploration ◽  
Cbd Stones ◽  
Recurrent Stone

Purpose. Laparoscopic common bile duct exploration (LCBDE) has been widely used to remove common bile duct (CBD) stones. However, surgery is not considered as the first treatment choice for elderly patients with CBD stones because of the potential risk of postoperative complications. This study aims to evaluate the safety and efficiency of LCBDE for elderly patients. Methods. From April 2011 to October 2016, 265 consecutive patients underwent LCBDE. We performed a retrospective study and divided these patients into 2 groups. The younger group was younger than 70 years old (n = 179), and the elderly group was 70 years old or older (n = 86). We compared patient demographics, clinical characteristics, intraoperative parameters, postoperative complications, and incidence of recurrent stone between the 2 groups. Results. The elderly patients had higher preoperative morbidity of chronic diseases, such as pulmonary diseases, heart diseases, arterial hypertension, and abdominal operation history ( P < .05). There were no significant differences between the 2 groups in terms of operation time, intraoperative blood loss, conversion rate to open surgery, total cost, overall complications, and incidence of recurrent stone ( P > .05). Conclusion. LCBDE can also be carried out as a safe and effective approach to remove CBD stones in elderly patients, although they have higher risk of chronic diseases.

scholarly journals Adding Ursodeoxycholic Acid to the Endoscopic Treatment and Common Bile Duct Stenting for Large and Multiple Biliary Stones: Will it Improve the Outcomes?

2020 ◽  
Author(s):  
Ahmad Hormati ◽  
Mohammad Reza Ghadir ◽  
Seyed Saeed Sarkeshikian ◽  
Faezeh Alemi ◽  
Majid Moghaddam ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Ursodeoxycholic Acid ◽  
The Elderly ◽  
University Hospital ◽  
Success Rates ◽  
Biliary Stones ◽  
Cbd Stones ◽  
Group A ◽  
Group B

Abstract Background and Objectives: The role of common bile duct (CBD) stenting in the establishment of bile stream in the elderly patients and the ones who are not good candidates for surgery due to not responding to treatments was well documented in previous studies. The current study aimed at investigating the effect of adding Ursodeoxycholic acid (UDCA) to CBD stenting alone in order to reduce the size or number of large and multiple CBD stones.Materials and Methods: Clinical outcomes including success rates in CBD stones clearance, incidence of pancreatitis, perforation, bleeding, as well as, decrease in size and number of stones and liver enzymes after a two-month period were assessed in the UDCA + CBD stenting group.Results: A total of 64 patients referring to Shahid Beheshti University Hospital in Qom, Iran with multiple or large CBD stones (above three or larger than 15 mm) received standard endoscopic therapies and UCDA + CBD stenting (group A) and controls only received standard endoscopic therapies + CBD stenting (group B). The mean reduction in the size of stones in group A was significantly higher than that of group B (3.22 ± 1.31 vs 4.09 ± 1.87 mm) (p =0.034). There was no difference in the incidence rate of complications including pancreatitis, cholangitis, bleeding, and perforation between the two groups (P >0.05).Conclusion: Adding UDCA to CBD stenting, due to decrease in the stone size and subsequently facilitation of the stones outlet, can be considered as the first-line treatment for patients with large and multiple CBD stones. Also, in the cases with large or multi stones may be effective in reducing size and subsequently stone retrieval. Trial registration number:The study protocol was approved by the Ethics Committee of Qom University of Medical Sciences (ethical code: IR.MUQ.REC.1397.075); the study was also registered in the Iranian Registry of Clinical Trials (No. IRCT20161205031252N8). This study adheres to CONSORT guidelines.

Is Gastrectomy Safe in the Elderly? A Single Institution Review

2011 ◽  
Vol 77 (4) ◽  
pp. 488-492 ◽  
Author(s):  
Eric S. Hager ◽  
Hamid Abdollahi ◽  
Albert G. Crawford ◽  
Neil Moudgill ◽  
Ernest L. Rosato ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Gastric Resection ◽  
Tertiary Care ◽  
The Elderly ◽  
The United States ◽  
Mortality Rates ◽  
Significant Difference ◽  
Group A ◽  
Group B

The population of the United States is aging. Studies within the last several years have demonstrated that major abdominal operations in elderly patients can be done safely, but with increased rates of complications. We set out to determine the rates of morbidity and mortality in elderly patients undergoing gastric resection at a tertiary care university hospital. A retrospective analysis was performed of 157 consecutive gastric resections between January 1998 and July 2007. Group A (n = 99) consisted of patients < 75-years-old at surgery, whereas group B (n = 58) included patients who were ≥ 75 years of age at time of surgery. These two groups had their clinical and demographic data analyzed. Postoperative length of hospital stay, perioperative major morbidity, and in-hospital mortality were analyzed using analysis of variance, χ2, and multivariate analyses. The average age of patients in group A was 57 years, compared with 81 years in group B. We found no significant difference in the percentage of gastric resections for malignancy (group A, 49% vs group B, 62%) or emergency surgery (group A, 10% vs group B, 10%) between age groups. There was a significant increase in length of stay in the older patients (11.7 days vs 17.6 days; P = 0.032), as well as major complications (11.1% in group A vs 27.6% in group B; P = 0.008). The in-hospital mortality rates approached significance (group A, 4% vs group B, 12%; P = 0.057). Gastric resection in elderly patients carries with it longer hospital stays, higher risk of complications, and in-hospital mortality rates despite similarity in patient disease. This information is imperative to convey to the elderly patients in the preoperative period before gastric resection.

The Short- and Long-Term Outcomes of Pancreatic Resection for Pancreatic Adenocarcinoma in Patients Older Than 75 Years

2016 ◽  
Vol 101 (11-12) ◽  
pp. 554-561
Author(s):  
Toru Aoyama ◽  
Masaaki Murakawa ◽  
Yosuke Atsumi ◽  
Keisuke Kazama ◽  
Manabu Shiozawa ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Pancreatic Adenocarcinoma ◽  
Pancreatic Resection ◽  
The Elderly ◽  
Surgical Mortality ◽  
Long Term Outcomes ◽  
Group A ◽  
Short And Long Term ◽  
Group B

The short- and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma have not been fully evaluated in elderly patients. This retrospective study selected patients who underwent curative surgery for pancreatic cancer at our institution. Patients were categorized into 2 groups: nonelderly patients (age &lt; 75 years; group A) and elderly patients (age ≥ 75 years; group B). The surgical morbidity, surgical mortality, overall survival (OS), and recurrence-free survival (RFS) rates in the 2 groups were compared. A total of 221 patients were evaluated in the study. The overall complication rates were 44.8% in group A and 52.6% in group B. Surgical mortality was observed in 2 patients due to an abdominal abscess and cardiovascular disease in group A (1.1%) and in 1 patient due to postoperative bleeding in group B (2.6%). There were no significant differences (P = 0.379 and P = 0.456, respectively). Furthermore, the 5-year OS and RFS rates were similar between the elderly patients and nonelderly patients (18.55 versus 20.2%, P = 0.946 and 13.1% versus 16.0%, P = 0.829, respectively). The short-term outcomes and long-term survival after pancreatic resection for pancreatic adenocarcinoma were almost equal in the elderly and the nonelderly patients in this study. Therefore, it is unnecessary to avoid pancreatic resection for pancreatic adenocarcinoma in elderly patients simply because of their age.

Laparoscopic common bile duct exploration: a safe and definitive treatment for elderly patients

2016 ◽  
Vol 31 (6) ◽  
pp. 2541-2547 ◽  
Author(s):  
Chufa Zheng ◽  
Yaokui Huang ◽  
E. Xie ◽  
Dejin Xie ◽  
Yunheng Peng ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Elderly Patients ◽  
Common Bile Duct Exploration ◽  
Definitive Treatment

Thirty-Day Mortality and Survival in Elderly Patients Undergoing Neurosurgery

Neurosurgery ◽  
2019 ◽  
Vol 84 (5) ◽  
pp. E270-E271
Author(s):  
Emily Rose Bligh ◽  
Yahia Al-Tamimi ◽  
Priyank Sinha ◽  
Daisy Smith
Keyword(s):  
Logistic Regression ◽  
Elderly Patients ◽  
Current Model ◽  
Frailty Index ◽  
The Elderly ◽  
Ageing Population ◽  
Predictors Of Mortality ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract INTRODUCTION With an ageing population and advances in neuroanaesthesia and critical care, there is an increasing subgroup of patients greater than 70 yr of age presenting to neurosurgical departments and undergoing surgery. We are now moving towards the idea of a frailty index. The aim of the current study is to investigate 30-d mortality and survival in this cohort following emergency and elective neurosurgery. METHODS Retrospective cohort study. All patients aged 70 yr and above, who had undergone a neurosurgical procedure from April 2015 to April 2017 were identified. Online patient electronic records were retrieved to gather information related to procedure type, co-morbidities, days in hospital, discharge destination, complications and mortality. Logistic regression analysis was used to identify predictors of mortality. RESULTS A total of 798 patients in total of whom 623 were <80 yr (group A) and 175 were >80 yr (group B). Male : Female = 3 : 1. Mean age of the study was 76 yr. There were 390 elective and 408 emergency admissions. Overall 30-d mortality = 5.6% (8% in group B). Overall survival was 86.5% in group A and 79.4% in group B. There was a significant difference in 30-d mortality between elective (0.8%) and emergency (10.3%) patients. About 84.5% of patients were discharged back to their usual place of residence in group A but this figure was 68.9% for group B. Logistic regression found emergency surgery (P > .001) and degenerative spine diagnosis to be independent predictors of mortality (P = .05). CONCLUSION The current model for accepting elderly patients is associated with a good overall outcome. The elderly should not be refused neurosurgery on their age per se. We have applied fairly strict and stringent criteria particularly in SAH and TBI.

Sign in / Sign up

Export Citation Format

Share Document